The review
shows that such conditions account for from 20% to 40% of the
panic disorder found in various medical populations and
that this group resembles conventional panic disorder in statistical
comparisons of age, gender and other demographic variables.

NFPD patients have attacks of intense ‘discomfort’ without ‘fear’.

They have the same sort of physical symptoms as conventional
panic disorder patients (e.g. heart pounding, chest pain, faintness,
trembling) but little anticipatory anxiety or subjective fears
such as fear of dying or losing control.

E.g. the authors analysed data for 49 cardiology patients who
cardiologists identified as having no evidence of coronary artery
disease. They had less inter-attack anxiety than panic patients
and were less likely to be rated as agoraphobic.

There are many case histories of people which negative physical
tests, who deny psychological problems but whose physical symptoms
can be relieved by anti-depressant or anti-anxiety drugs.

e.g. a surgeon who had lost a patient and his partner a few months
before he started having attacks (fainting) before difficult operations,
but denied needing psychiatric help.

Conclusion. Cognitions are not an invariable factor
in panic attacks, and the ‘3-systems’ or ‘triple-response’ view
of anxiety is consistent with the syndrome.

A more recent report on the high percentage (25-43%) of patients undergoing cardiac investigations who turn out to have no evidence of coronary disease is Carmin et al. (2003).

See also Fleet et al (1998) below — it is more typical to find cases where cognitions are a part of panic disorder [not included in paper handout]

In the case below it seems likely that being diagnosed as having coronary artery disease predisposes patients to having panic attacks involving fear of heart attacks.

Fifty-seven percent (250 of 441) of these patients were diagnosed as having noncardiac chest pain and constituted this study's sample,

A total of 30% (74 of 250) of noncardiac chest pain patients had a documented history of CAD.

Thirty-four percent (25 of 74) of CAD patients met criteria for PD.

Patients with both PD and CAD displayed significantly more psychological distress than CAD patients without PD and patients with neither CAD nor PD.

However, they did not differ from non-CAD patients with PD.

PD is highly prevalent in patients with CAD that are discharged with noncardiac diagnoses. The psychological distress in these patients appears to be related to the panic syndrome and not to the presence of the cardiac condition.